Effect of Concomitant Antiarrhythmic Therapy on Survival in Patients with Implantable Cardioverter Defibrillators

Abstract

In patients with ICDs, beta-blockers had a favorable effect on survival. Sotalol and amiodarone had a neutral effect on survival. There was a trend toward a deleterious effect with digoxin use. These findings suggest a need for further investigation addressing survival effects of antiarrhythmic drugs when given concomitantly in patients with ICDs.

Independent predictors of mortality in patients with advanced heart failure treated by cardiac resynchronization therapy

“…In this study, no increased mortality was documented. 26 Ho et al 27 and Singh et al 28 showed a neutral effect on the survival of ICD patients. Unfortunately, these studies do not report on the composition of single-, dual-and triple-chamber devices.…”

Use of β-Blockers in Patients with an Implantable Cardioverter Defibrillator

“…23 However, in another observational study, use of β-blockers of unspecified duration following ICD implant was found to be significantly associated with a survival benefit after adjustment for a limited number of unspecified variables. 24 For patients who received an ICD for primary prevention of SCA, an analysis of patients from MADIT II found that β-blocker use among those who received an ICD was associated with a significantly reduced risk of hospitalization due to heart failure (HR 0.59; 95% CI 0.43 to 0.80), and the authors suggested the need for prospective evaluation of adjunctive medical therapies, such as β-blockers, in future ICD trials. 25 Another post hoc analy- sis of data from ICD recipients in MADIT II found βblocker use to be associated with significant improvement in survival compared with nonuse of a β-blocker (unadjusted p value = 0.001).…”

Effects of Cognitive Behavioral Stress Management on Negative Mood and Cardiac Autonomic Activity in ICD Recipients

“…Implantable cardioverter‐defibrillator (ICD) recipients are at particularly high risk for development of ventricular arrhythmias, including emotionally triggered arrhythmias, which may precede up to one quarter of arrhythmic events and potentially be preventable by this approach, adjunctive to traditional device and pharmacological therapy. Device therapy alone treats the arrhythmia itself and not the triggers to its initiation, and pro‐arrhythmic effects of antiarrhythmic drugs may negate some of their benefit . Previous clinical trials of behavioral intervention in ICD recipients have revealed variable significant improvements in anxiety, depression, and psychological distress but have been limited by small sample size, high attrition rate from dropouts, and differences in study design, and no consensus has emerged as to its widespread clinical application.…”